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Gaebel W, Zäske H, Hesse K, Klingberg S, Ohmann C, Grebe J, Kolbe H, Icks A, Schneider F, Backes V, Wolff-Menzler C, Guse B, Gallinat J, Bock T, Jockers-Scherübl MC, Krüger T, Jessen F, Bechdolf A, Kircher T, Konrad C, Falkai P, Schaub A, Rudolph M, Köllner V, Schmid-Ott G, Linden M, Lieberei B, Stuhlinger M, Sommerfeld S, Schumacher A, Krenge S, Gereke S, Mönter N, Navarro-Urena A, Frosch G, Kuhlbusch FJ, Cleveland H, Riesbeck M. Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT. Eur Arch Psychiatry Clin Neurosci 2020; 270:501-511. [PMID: 31520149 DOI: 10.1007/s00406-019-01064-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022]
Abstract
There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment ('STEM'). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3-F31.5, F32-F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients' treatment benefit. However, factors contributing to improvement need to be explored.The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
- WHO Collaborating Center for Quality Assurance and Empowerment of Mental Health, LVR-Klinikum Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany.
| | - Harald Zäske
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Hesse
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Christian Ohmann
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Grebe
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Henrike Kolbe
- Coordination Center for Clinical Trials, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Diabetes Center, Düsseldorf, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
- University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Volker Backes
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Aachen, Germany
| | - Claus Wolff-Menzler
- Department of Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Birgit Guse
- Department of Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Timo Krüger
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Oberhavel Kliniken GmbH, Klinik Hennigsdorf, Hennigsdorf, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Annette Schaub
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Rudolph
- Mittelrhein-Klinik for Psychosmatics and Rehabilitation, Bad Salzig, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Mediclin Bliestal Clinic, Blieskastel, Germany
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | | | - Michael Linden
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | - Barbara Lieberei
- Department of Behavioral Medicine, Rehabilitation Center Seehof, Teltow, Germany
| | - Monika Stuhlinger
- Psychiatric-Psychotherapeutic Rehabilitation Center grund.stein, Tübingen, Germany
| | | | | | | | | | | | | | - Günter Frosch
- Psychiatric Practices Düsseldorf, Düsseldorf, Germany
| | | | - Helen Cleveland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- WHO Collaborating Center for Quality Assurance and Empowerment of Mental Health, LVR-Klinikum Düsseldorf, Bergische Landstr. 2, 40629, Düsseldorf, Germany
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Abstract
BACKGROUND Wisdom is a capacity, which is needed in coping with difficult problems in life. It can be understood as a special type of problem solving skill. It is getting growing recognition in psychology in general, and in psychotherapy and clinical practice in particular. Goal of the present study is to assess wisdom competencies and their correlates in psychosomatic patients, using for the first time the 12-WD-scale. METHOD The 12-WD-Scale covers 12 wisdom dimensions. As part of their routine intake assessment, 202 unselected inpatients of a department of psychosomatic medicine filled in the 12-WD-scale together with the differential life burden scale, the global belief in a just world scale and the posttraumatic embitterment scale. Additional patient and clinical data could be taken from the routine data. RESULTS Wisdom scores showed a normal distribution. The mean was in the positive range (4.50, SD=0.71). A factor analysis showed three factors (sobriety, serenity, modesty), explaining 53.7% of the total variance. There were positive correlations of the wisdom score with life satisfaction and age, negative correlations with beliefs in justice and embitterment, but not with formal education. DISCUSSION The results of the 12-WD-Scale show that psychosomatic patients appreciate wisdom attitudes and that this is associated with better coping in life. Wisdom competencies are an interesting field in psychotherapy when patients are burdened by difficult situations in life. The 12-WD-scale can provide helpful information in this regard.
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Affiliation(s)
- Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité Universitätsmedizin Berlin
| | | | - Nils Noack
- Research Group Psychosomatic Rehabilitation, Charité Universitätsmedizin Berlin
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